Should doctors support Congress’ health reform efforts?

The American Medical Association recently gave unqualified support to the House health reform bill, H.R. 3200, and that is drawing the ire of some of their supporters.

To be sure, H.R. 3200 is the most left-leaning of the proposals, and there is clear ideological opposition to the so-called “public plan,” which expands the government’s role in our health care system. It’s a tremendously sensitive topic, with some expressing their outrage (to put it gently) in private e-mails to me.

The AMA has joined other professional societies, including, the American College of Physicians, the American Academy of Family Physicians, American Academy of Pediatrics and the American Osteopathic Association, in support of the bill.

The Wall Street Journal, however, wrote a scathing view of the AMA’s support. In today’s lead editorial, they write that the AMA, along with other lobbying groups, are “putting their short-term self-interest — usually ensuring that government programs remain generous (enough) — ahead of the long-run threats.”

I’ve previously written that it’s tremendously important for doctors to present a unified front, since it’s easier to ignore fragmented voices. But, should doctors support the current, albeit seriously flawed, reform efforts?

I believe the answer is yes, and I understand that there is significant opposition to that stance. Despite reservations about the current approach, including, the threat of a “strong” public plan that uses Medicare (under)payment rates, it does remove the unacceptable sustainable growth rate formula that determines Medicare physician reimbursement, which is a much-needed step forward. Furthermore, it makes an attempt, admittedly paltry, at increasing the pay of beleaguered primary care doctors, who will form the backbone of any reform effort. Is that far too little to settle for? Perhaps.

But a more important question is, what if reform doesn’t pass? It’s quite possible that preserving the status quo will be far worse for doctors going foward than the current proposals. I also believe that it’s important for doctors to “get a seat” at the table, lest they be marginalized further if they don’t.

I cited a quote from Paul Krugman a few months ago, where he wrote something along the lines of, “the perfect is the enemy of the good.” He was referring to the single-payer supporters and grassroot reformers who felt that Congress’ proposals didn’t tilt enough to the left, and as such, oppose the current efforts.

I think that sentiment goes both ways. Some reform is better than none, and doctors advocating for a free market-based system shouldn’t hold out, hoping for the perfect package.

Should doctors support Congress’ health reform efforts? 41 comments

Comments are moderated before they are published. Please read the comment policy.

http://www.getbetterhealth.com Dr. Val

I skimmed all ~1000 pages of the house bill and ~600 pages of the Senate HELP bill. These bills are NOT ready for prime time. There are lots of weird budgetary allocations without a clear explanation of what they’ll be DOING with the money – other than creating a committee to decide what to do later on. That’s just NOT ok. We’re not even close to having a “good” bill that could be an enemy of perfect. Seriously – go read some of this stuff and you’ll be shocked. I was.

SarahW

Act in haste, repent at your leisure.

SarahW

In other words, rushing without understanding the proposed reforms, for some temporary or even imaginary benefit, is likely to be a course more foolish than moving slowly.

Physicians will always have a seat at the table, and they don’t lose it by objecting to the stillbirth that is Obamacare.

Frank57

@SarahW: I don’t think it’s true that docs will always have a seat at the table, as a matter of birthright. In the past when docs refused to be at the table unless we got everything we wanted, we were left out, and bad things happened. If docs get obstinate, we will be left behind, with our only recourse being the rear-guard actions and passive aggressiveness of the past 2 decades. Note: This DOESN’T mean we have to abandon our principles. It merely recognizes that we aren’t the only players in this game.
@kevinmd I don’t read the AMA support as unqualified. There was enough nuance in the AMA statement to suggest that they don’t think it’s perfect, but is the best place to start working on the details.

Dr. Mary Johnson

Kevin, I am sorry, but from my perch in the “cheap seats” of medicine . . . having taken the-beating-of-a-lifetime at the hands of the way over-paid, way over-rated business-school grads running my hometown “non-profit” hospital . . . non-profiteers who got a free pass/suffered no scrutiny whatsoever because government oversight is a fundamental joke . . I am sick and tired of the notion that physicians have to compromise . . . that “some” reform (no matter how fundamentally “not ready-for-prime-time” it is) is better than no reform.

That’s how we landed in the boat we’re currently in . . . from a tort system that is totally out-of-control . . . to a fundamentally useless system of medical peer review . . . to privacy regulations that often defy common sense . . . to the entitlement programs endemic to our 50-year old welfare state that do absolutely NOTHING to set reasonable limits or encourage personal responsibility.

I’ve told my friends, I never should have gone to medical school. I should have dropped out of high school when I was barely out of my teens, had five or six babies by multiple fathers (never marrying any of them) and lived happily-ever-after in public housing – never working a day in my life.

As someone who did work her arse off and went to school and got the education (only to be told by the idiots running the aforementioned “non-profit” that, “Good Pediatricians are a dime a dozen.”), I’ve been footing the bill for other people’s screw-ups & happy pursuits (in one fashion or another) my entire life, getting royally screwed in the process. And I’m DONE.

Bad laws were passed in a hurry because people caved or compromised or were just not paying attention.

The status quo is letting it happen again. NOW is exactly the time for foresight and dissent . . . lots of dissent . . . for doctors to stand up to their lameo “advocacy” organizations and say, NOT NO, BUT HELL NO!

I personally don’t give a rat’s tail what the AMA and AAP want, because they were NEVER there for me.

OBTW, I double-dare you not to moderate this out.

Tom

A reposted comment from the earlier topic today, but it seems more appropriate to this topic here…

The case for health reform often hinges on, “Something has to change”, or “Change is inevitable, and we should be there helping to shape it”.

The fallacy in this is that we must accept the changes proposed as good, right, and proper. However, if we see them as deeply flawed, and likely to do more harm than good, we are duty-bound to oppose them, and indeed, seek to ensure that the efforts at reform fail. Change for its own sake is simply stupid. There should be a rational cost-benefit analysis, and that is simply not being provided by those “shaping change”. Further, we are being marginalized regarding any real decisions regarding reform; rather, our presence serves to validate a politcal process that has very little to do with medicine.

At this point, rather than allow ourselves to be used as scapegoats for the horror that has so far been presented to us as reform, we should have the courage to denounce it for what it is: a naked power grab that has nothing whatever to do with medicine, and is all about expanding the role of the state. We are physicians, not politicians. By supporting this “reform” we are moving out of our caregiving roles into social justice, where we have no training and rely on what we feel, rather than rational considerations.

Is reform needed? Sure. Should it come from the government? No. The government already plays a distorting role in healthcare with Medicare and Medicaid, and has contributed heavily to the systematic devaluation of primary care. Considering what the government has done to us thus far, I trust the free market much more than another top down government program.

Tom

Just as an aside, I think it highly amusing that the AMA guest posts here do not allow comments. Are they so afraid that others might hold different opinions? Come to think of it, I do understand their reluctance to entertain other opinions. After all, when you’re convinced you’re right, why waste time listening to your constituency?

Dr. Mary Johnson

Tom, I had noticed that as well.

It speaks volumes.

http://fertilityfile.com IVF-MD

I have voiced this option several times and have yet to get a single rebuttal from ObamaCare supporters. Why not try this on a state by state basis? Maybe choose 2-10 states to try this on. Wait two years and see if life in those states is better or worse and then if worse, work to repeal the new changes (good luck) and if better, go ahead and implement the changes in the rest of the states. I’ve received replies from ObamaCare opponents pointing out that Massachusetts and the Hawaii children’s programs are already examples of failure of govt-controlled medicine. Any reason why it wouldn’t be smarter and safer to implement any new sweeping changes on a limited state-by-state level first? We could argue all day on whether govt controlled healthcare is better or worse, but as rational scientist, why don’t we just experiment partially rather than experiment completely (as would a complete change)?

SmartDoc

Anybody who supports a vast, basically secret, probably uncontitutional legislation prepared by a sorry collection of corrupt totalitarians, is a fool.

http://www.thehappyhospitalist.blogspot.com Happy Hospitalist

If everyone was happy, we would all be broke

what is the other Option – Status Quo?

Why would ACS( surgery) , ACP,AAFP, AMA and others endorse this bill. AMA opposed enacting Medicare strongly. Those bills don’t have Obama’s stamp yet, they will get a defit neutral bill in the end, they have no choice on this. If we go another 10 years or 15 years without change, we’ll really be boiling in a rut. I think people really really need to feel the heat not just know where it will lead us and given tons of money for vested interests, why would they give up anything without a war. Patients have the least influence in this and they have no seat at the table. Congress worries about next election, private insur about their share holders. It took a Herculean effort for medicare to be enacted and with current elecronic age and fear mongering, it will a really heavy lift for this admin. It was not done for 50 years for a reason, IT IS DAMN HARD! We sooo need it and lets be on the right side of history and supportthe efforts.

http://www.thehappyhospitalist.blogspot.com Happy Hospitalist

BTW, I think the only thing that will financially save America and prevent the bankrupting of our country has nothing to do with government vs private insurance. The point is moot. Under current payment models both have proven a morbid failure.

What does matter is how we pay for medical care. To save MedicareAmerica, we will have to

Kevin — well-reasoned and courageous coming out with this. You are right that this reform is not perfect, but it’s an improvement. Actually, for all the heat and light surrounding the public plan, the most important elements of the bill are established (and almost being overlooked). Namely, guaranteed issue, community rating, no recissions, and the National Insurance Exchange, in addition to the Employer mandate and the individual mandate.

As a progressive, as a doctor, and as a small-business owner, I’m happy just with that, even if we get no more. I think Obama is right to push for a better deal, if we can get it. But the key reforms appear to be agreed on at this point, and that’s a great accomplishment.

You’re right — the perfect should not be the enemy of the good, and what we have so far is very good indeed.

shadowfax

IVF MD,

The nest reason not to “experiment” with these reforms is because reform is very hard, and we may only get one shot at this. We have the pro-reform party in charge of both houses and the White House, and for the first time in 40 years there is a chance of getting comprehensive reform passed. If we restrict ourselves to tinkering, the likelihood is that in two or four years the political opportunity for national reform will be gone.

I would also argue that there is an urgency contributed by the 50 million uninsured, but that argument is sadly undermined by the fact that many of the reforms may not be in place till 2013.

Finally, there are practical obstacles to regional implementation. Can the federal government mandate (for example) community rating for insurance companies in only part of the country? I dunno; there seem to be equal protection issues there, but I’m no lawyer. More saliently, many of the commissions that are proposed (like IMAC and the OCE) are federal by their very nature. Comparative efficiency can’t be regionalized easily.

David

Tom is right on. Government can’t really solve the problem because government IS the problem.

The notion that health care is a right is a problem.

The notion that the government has any business providing health care or health insurance is a problem. (I might understand the VA system, but it would probably have worked better just to provide them with insurance and not create a separate system).

People are SO confused and misled on this topic that they just want to cry. “If Obama’s change isn’t right, then what is?” they whine. We can’t just accept the status quo!

The massive obfuscation of these pleas is sickening. It is Medicare and Medicaid that have contributed to the massive explosion in expenses in this country on medical care. The government has introduced massive price inflation into the system (witness medical care costs as a percentage of GDP since the 1960’s when these programs were introduced – changing rapidly from 6% to about 16% of GDP!). It should be clear to everyone that when something is free, or nearly free, for patients, then they want it all. It should be clear to people that if the government is willing to pay big bucks for technology and other medical care, that doctors will provide it and set their prices accordingly. This is simple economics – it is no one’s fault but the fools who put the programs into effect in the first place.

The tremendously tangled, expensive, and despite this, still effective, medical system is a product of massive government intervention. This occurs at the local level, state level, and federal level. Tax laws favor employers providing health benefits, greatly reducing the portability of health insurance and tying people to their jobs. City governments decide which clinic or hospital will open up and for what. EMTALA laws hamstring private hospitals, turning all hospitals into forced welfare programs. Medicare essentially owns the elderly market – and controls nearly every important aspect of how health is delivered to them.

Health insurance companies are massively regulated, such that it is determined what they can charge, when they can change their prices, and what products they must offer. States can put an insurance company out of business at a moment’s notice. Do you think you could do better than these companies under such circumstances?

People who believe in communism (or extreme liberals, we’ll say) don’t realize that all their laws and rules to force people to behave the way they want usually (1) result in a massive slowdown in the system and lead to inferior products and (2) usually don’t guarantee the outcome they originally intended anyway. It is precisely because health care is considered so important to the liberal that he/she has focused on it so much – and because of this, has hampered it so much. (If liberals cared about software engineering to the same degree, then that sector of our economy would also be over-regulated).

So…. it is ironic that people with the mindset that brought about all this regulation in the first place are now complaining that something must be done about the ‘status quo’! Instead of recognizing the error of their ways – they want to introduce even more government control into the system.

The real answer is: dismantle all the taxation laws and controls that are currently hampering medicine. It isn’t sexy, I know, but undoing the harmful laws and regulations is the ONLY answer that will actually work.

Susan H

Deregulate everything, let everybody figure out ways to medically treat themselves according to their own scale of valuations.

Kevin, You sir are a sell out. Don’t let your media attention go to your head. And no we should not all collectively agree to a poor plan. Our country is bankrupt. We have a problem saying no to our country. Public insurance is nothing more than perpetuating our nations spending problems. Medicine happens to be the front line issue of spending, and you are advocating we continue to burn the benjamins. This is ludicrous.

alex

Nothing infuriates me more than acting like not implementing the SGR cuts is some kind of victory. Anyone who thought Congress was going to cut Medicare payments 20% this year if the AMA did nothing is an idiot. SGR cuts are a hollow threat and claiming that getting them removed is the backbone of a victory demonstrates just how little in this bill is good for doctors (i.e., nothing).

Matt

We’ve decided we need “reform” so let’s title anything we need as “reform” and thus that means it’s good! Because we have a “crisis”. Physicians and taxpayers shouldn’t bother asking what’s on the menu. It’s you.

http://content.healthaffairs.org feminizedwesternmale

HaHaHaHaHaHaHaHaHaHa!

Don’t just do nothing, stand there…

Let’s see, 100 trillion, as is, with current entitlements, in the the next generation. Bankrupt.

4.3 Trillion dollars into money hole incinerator. Check.

Squeamish doctors show typical backbone, jump at chance for short term ability to take one lick at ice cream flavor of Retribution. Yum.

microcosm of USA, see health care.

Let me end with my all-time favorite newspaper article, paraphrased:

People Stay in Line at DMV After Man Defecates on Floor.
from Charleston.net (Associated Press). Saturday, July 21
SPARTANBURG – Long lines at the Division of Motor Vehicles and no on-site janitor left a man’s feces sitting on the floor for two hours when the customer had a medical problem in the waiting room.
David Burgis, the division’s deputy director, said no janitor is at the Fairforest Road office here to handle emergencies.
The cleaning service is contracted through a service that cleans the building once a day, Burgis said.
The office manager asked the man’s daughter to take the man to the bathroom, but she refused. The manager called the cleaning service, but workers could not respond immediately.
Brenda Hatcher, who was in line, said some customers left, but most stayed because they didn’t want to give up their place in line.
“There was never any thought to close the office because there were so many people in line,” Burgis said.
Workers changed the line configuration and taped off a chair so customers could avoid the fecal matter the man spread over several areas of the room.
The man did get his driver’s license renewed and left about an hour after the accident.

http://www.familydocs.org/blogs/fp-forum Carla Kakutani MD

Kevin, I’m with you. If history repeats itself it will be another 20 years before a chance to make significant reforms comes around again and that’s just way too long for millions of people getting lousy care or no care in our current system. I look at this as a patient: right now if I got fed up with my multispecialty group and wanted to put up my own shingle, I would not be able to get health insurance for my husband at any price. I have tons of patients in a similar boat, one stroke of bad luck (a divorce or loss of a job)away from having to “go bare” and risk personal bankruptcy. This unfettered free market utopia that docs want to have just doesn’t pan out in the real world of people scratching to get by.
This isn’t perfect reform but it sets the stage to make some real changes to how care is paid for, which will change how it is delivered, which will help raise up primary care. Think anyone is going to give a hoot about primary care if the incentives don’t change?
And not having to go to Washington every year to fight off the SGR cuts will be a real time-saver…..we can all stay home and practice medicine for a change!

anonymous

can we pass a law that people have to have health insurance before they can get cable tv? an ipod? sure people get into some trouble due to unanticipated health care expenditures, but it is not at all clear that they are saving appropriately in the first place. if you are in your 20s and in good health and choose not to be insured, then you should not be counted in the 47 million uninsured.

this plan is a terrible plan. they haven’t even finished writing it yet. rushing because it is our ‘only chance for 20 years’ is a terrible reason to push something this important through. how about other platitudes-‘things can always get worse’ or ‘the more things change, the more they stay the same’?

Matt

“And not having to go to Washington every year to fight off the SGR cuts will be a real time-saver…..we can all stay home and practice medicine for a change!”

I’m sorry, are you saying that when government gets MORE involved in healthcare there will be less lobbying necessary? If so, this kind of naivete will not serve you well in the coming healthcare regime.

http://www.ama-assn.org J. James Rohack, M.D.

As the largest physician group in the US, we see our position at the center of the health reform debate as an honor and a serious responsibility. Maintaining the status quo is not an option and the AMA is committed to achieving health reform this year that provides all Americans with affordable, high-quality health care. As the bill moves through the legislative process, the AMA will be at the table to improve the final legislation, including pushing for liability reform.

HR3200 includes many key provisions for effective, comprehensive health reform. It establishes a health insurance exchange that would provide a choice of plans to the uninsured, self-insured and small business employees, with voluntary physician participation. Reform of the broken Medicare physician payment formula is needed and the bill erases the SGR debt. It also includes an end to insurance coverage denials based on pre-existing conditions and adds funding for primary care services, without reductions on specialty care.

No other physician group in the nation allows all physicians a voice in the future of medicine in our country. We urge all physicians to join us in our quest to pass health reform this year that better serves patients and empowers physicians to deliver the highest quality care.

J. James Rohack, M.D.
President, American Medical Association

Dr. Mary Johnson

Spot-on observation anon 9:16. A huge portion of the 47 million uninsured are in their boats by their own doing and their own choices.

Speaking of choices, trusting the government to do what it said it would do – and handing the “businees” end of medicine over to non-profiteers was a HUGE mistake that I made fairly early on in my career. I’ve been paying for that naivete ever since.

It simply amazes me how many people are willing to take the path of least resistance, ignore ALL of the evidence right in front of all of us, and fall into the same traps over a decade later.

Obama fear-mongering at a Children’s Hospital yesterday made me want to barf.

When the government this Pediatrician once served faithfully and well . . . the government that stood by DEAF, DUMB and MUTE as she got the huge CLUSTER-SCREW . . . steps in to make things right, that will be change I can believe in.

Not holding my breath.

Karl J. Edelmann MD, MBA, CAQ-G, FAAFP

As an member of the AMA since medical school with nearly 3o years in the organization, a former county, state, and national officer, and a private solo Family Physician for 20 years, I am appalled by the AMA support for HR3200. We are being sold out. We need reform, not destruction. Medical care is given when needed by primary care physicians and those specialists in the community that can and will provide the support. But, as medicine is touted as a safe “job” for the future, we are having many enter the field who are in it for the money, not for care.
With all due respect to Presdent Rohack, this is the wrong bill, at the wrong time, with the wrong priorities. We need liability reform before payment reform. We need an emphasis on preventive instead of curative care. And we need to reestablish that the AMA is advocating for physicians and patients, not other providers (RN’s, PA’s, Psychologists, etc.) that the current congressional leadership feels can be used to “rein in” medical costs. “Efficient” medical care does not need EMR’s and rapid transit of claims. It needs specialists to see patients in the same time frame as PCP’s. It needs legal reform to stop the lottery of malpractice that leads to unnecessary and wasteful testing. It needs Congress and the states to stop unfunded mandates and provide meaningful direction on what will and will not be covered and why. It needs a lot more than Congress is willing or able to talk about right now. The AMA should withdraw its support of HR3200 before it becomes a flip-flopping pariah and useless mouthpiece for political correctness instead of the strong physician advocate it has been.
After nearly 30 years of membership, I have to wonder whether the AMA has left me before I leave it.
KJE

http://www.kevinmd.com Kevin

Ok, it’s time to take a time out.

I understand the passion that health reform brings out. But comments on the blog must take a civil tone.

Doing otherwise, such as including personal attacks and unrestrained ranting will be deleted immediately.

Dr. Johnson, I have received several requests that you cease referring to your experiences where you were unfairly treated. We all sympathize, and I’m sorry that happened to you, but we get the picture. You do not need to refer to them in every comment.

So, from here on forward, any further mention of them will cause your comment to be deleted.

Furthermore, I continue to reserve the right to delete any comment on this blog for any reason at any time. And I do not need to explain what my reason is.

That’s it. Now carry on.

Kevin

http://www.thehappyhospitalist.blogspot.com Happy Hospitalist

Dr Rohack, closing your comments to commentary is the same as telling your mother to keep her mouth shut. Both are rude and disrespectful.

Moving on…

Certainly, increasing access to care for all American’s is noble. Certainly removing pre existing conditions as a prerequisite for insurability is necessary.

The empowerment you speak of is jibberish. We have a cost control problem in this country. This bill does nothing to control costs. We are paying to much to too many people to do too much. Putting your full weight behind a bill that accelerates the bankrupting of this country makes the AMA part of the problem.

Do you want your grand children to pay the 99 trillion dollar bill come due in their life time?

I would support a bill that hold physicians accountable for the care they provide. I would support a bill that holds patients accountable for the care they receive. I would support a bill that holds government accountable for the money they provide.

Right now, Obama and company ( you included) are supporting a bill that holds no one accountable for anything.

By choosing access over cost, you and your organization will go down in history as one of the many that fed from the trough, claiming to compromise on everything, yet solving nothing.

Tom

Let me get this straight:
“Maintaining the status quo is not an option and the AMA is committed to achieving health reform this year that provides all Americans with affordable, high-quality health care.”

I’m focusing here on the words “affordable” and “high-quality”. The services we provide fall under the engineering rule: Fast, Cheap, Good: Pick 2. So, if we follow the rules, that means a long delay in receiving healthcare, right? This is where we’re going… Rationing by delay, as has been seen in Canada and England. No thanks.

Why do you state that the status quo can’t continue? If it is so fundamentally broken, why does it work so well? Why must we accept the “reform” being offered to us, rather than demanding better? The bill does not improve care for the majority of americans, but rather imposes conditions on the marketplace that likely make care for the majority worse. That would, in my mind, make it a bad bill.

Solutions for Healthcare

If we want personal responsibility then we should not require doctors, hospitals, etc to treat patients without payment. We should have a special fund to clean up the mess when necessary. Those that choose not to carry insurance live (or die) with the conseqences.

No doctor contracts with insurance companies or medicare/medicaid and price transparency. If the insurance doesn’t pay what the doctor wants, the patient can fork over the rest or go without treatment.

Have a medical injury fund which compensates patients for medical errors. Refund the patient’s money and review the competency of the doctor.

Doc99

When I go to a restaurant, if I don’t like the way the meal was prepared, I can request they take it back and redo it to my liking. Why cannot these so-called public servants take their “reform” back to committee and keep taking it back until they get it right? Don’t they work for us? Or am I wrong?

Dr. Mary Johnson

Dr. Pho, Dr. Rohack, at the risk of having my voice at your table moderated out, according to DRUDGE this evening, the President of the United States is not completely familiar with the specifics of his own healthcare reform bill – the one he wants to ram down our throats in a matter of weeks:

Yet we, as physicians, are supposed march blithely and blindly behind this man . . . and the AMA?

shadowfax

Dr Johnson,
Yeah, when someone just made up something pure and simple about the House bill, Obama wasn’t familiar with that because it’s a flight of fancy. I can see that it’s the right-wing meme du jour, popping up from Michelle Bachmann and heading out from there, but it’s BS, and no wonder that Obama was not “familiar” with it.

SF

Dr. Mary Johnson

Respectfully shadowfax, what you brush off as “made up” or a “flight of fancy” appears rather to be a reasonable set of deductions based on the language of the bill (as well as what we have seen happen in the past – of course, I can’t refer to personal experience) of what could happen as this bill is currently written.

In short, ramming this thing through with little real imput from doctors (apart from the AMA) and practically ZERO debate demonstrates an alarming lack of foresight.

We’re already dealing with loads of “unintended consequences” of other laws passed as knee-jerks to one problem or another (HIPAA and HCQIA come immediately to mind).

P.S. Be careful. “BS” might be perceived by some as “unrestrained ranting”.

Doc99

Even the President admits these bills all need work –

Obama, asked on NBC’s “Today” show whether he would sign any of the bills working through Congress, said, “Right now, they’re not where they need to be.”

Physicians are being sold a bill of goods with this. The government never steps away from something with this many votes at stake. It merely gets in deeper, no matter how poorly this “reform” goes. If it stinks, it will only be evidence that we need MORE government.

Why the AMA backs this I have no idea, as the only option for physicians to take back their time and control of their livelihood is by backing away from the third party payment model.

Kevin asks this question: “But a more important question is, what if reform doesn’t pass?”

Then you still have a lot of control over your future. Currently about 50% of the cost of healthcare is paid by the government. Do you think this “reform” will increase or decrease that number? If it’s the former, how does this help the physician? Does his/her bargaining power INCREASE against the federal government?

Right now you still have a lot of patients out there that could transition to a more direct payment system. As more and more pay via their taxes, their appreciation for your work goes down (after all, I pay my taxes, where’s my healthcare?) and your ability to be paid more based on your skills declines.

In no way, shape or form is this good for physicians. And as a result, it’s not good for patients either.

Michael Riesberg MD

I can understand the blogs of the above members, including Dr Johnson. I LOVE medicine but I honestly hate the SYSTEM that FORCES us to comply and takes away our freedoms. EMTALA, HIPAA, Red Flag Rules, HIT/Outcomes Research, and CMS/Medicare Audits all have ATTACHED PENALTIES for non-compliance. No wonder MORALE among physicians is at an all-time low. TOM DASCHLE—especially in his book “Critical”, unilaterally blames PHYSICIANS for the cost of health care. He FAILS to SPREAD THE RESPONSIBILITY to hospitals, PHARMA, and Insurance Companies—-why? Because—Daschle is a HIGHLY PAID LOBBY member representing these entities. Daschle wants a FAST/HASTY passage of “ANY form of reform” in order to PREVENT OPPOSITION. The AMERICAN PUBLIC has no problem forking-over millions of dollars to athletes, entertainers, politocians, and lawyers. Are they getting a BETTER PRODUCT today versus in the 1950’s or 1960’s? In medicine, more people are SURVIVING today versus in the 1950’s and 1960’s—–including TRAUMA, pediatric/neonatal, and the list goes on. Yet our society COMPLAINS on spending for those areas that IMPROVE their quality of life. Final Point——our biggest enemies in government are OVERSPENDING and HIGH TAXES. Until we stop punnishing the small businesses and professionals in this country, it will be hard to get back on our feet. Like Dr Johnson and many other physicians, I feel that most of my work and sacrifice goes to taxes and pleasing government—-yet what I get in return is increased REGULATION —-and unlike other SMALL BUSINESSES, I DO NOT feel that I have the same rights as other small business owners—or for that matter, the same rights as administrators in the health care system.

patrick garrett RN

There can’t be a right to any one’s labor. If a “right” like that exists, what other “rights” are we unaware of? The right to food? The right to a shelter? The right to clothing? How is the distinction being made that health care is a right, without referring to who is to provide that right?

EM Physician

I find it so easy to find docs everywhere who are against health care reform. They don’t want government involved. They don’t want patients having access issues. They are against rationing. They don’t want death panels (expect for Billy Mallon)….really??

Let me summarize it for you, they don’t want to change. Someone is threatening to move their cheese, and they are mad about it.

As a first year I have a lot of ties to people practicing within the field. I agree reform needs to happen but why would we leave reform up to lawyers/politicians. Isn’t that a conflict of interest. The AMA has made a mistake by quickly rushing out and supporting a bill rather than saying, “we support healthcare reform and but at this time have not seen a bill which we feel addresses the core principles that need reformation”… if something like that was said they could still cover their behinds as well as accurately represent their members.

The other side of reform that I rarely see addressed is the physician shortage that will ensue. My brother in law is an anesthesiologist and has cut back hours as to stay under a tax bracket. My uncle is considering moving to a cash only practice (he has already stopped seeing medicare and medicaid patients, not because he is in it for the money but because he doesn’t have the time to deal with the piles of paperwork and other issues that follows patients using that type of payment). As well, several Emergency Rooms within the town I live in have converted to urgent care clinics. From my understanding this is so they aren’t stuck with treating patients that don’t have insurance. Its scary to imagine what other ‘changes’ will manifest as health care reform is passed. Its like influenza, its not a matter of if, but when.